The challenges identified earlier are likely to remain central for the foreseeable future. But new issues are also emerging: case study respondents in the six states under study indicated that family coverage under SCHIP is a topic of growing interest. While some states have already obtained approval for such programs, an increase in the number of states proposing both these arrangements and other, new approaches is likely in light of the flexibility recently offered under CMS' Health Insurance Flexibility and Accountability (HIFA) initiative. The impact of these programs on the number of low-income, uninsured individuals and also on the profile of the Medicaid and SCHIP programs will, along with operational issues, be of great interest.

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